| NPI | 1548821507 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY TUPPER Owner 307-746-8108 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 363LP2300X Nurse Practitioner, Primary Care | |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2024-01-16 |